Gaza medical staff: “We are alive, but we are not OK"

Medical staff bear the burden in times of war

MSF psychiatrist Dr. Audrey McMahon, who recently returned from Palestine, said medical staff in Gaza are working under profound psychological strain. 

“Many times, because of the bombardments or because of the insecurity, medical staff had to leave patients behind. Many of them have a shared feeling of guilt for not being able to do more,” said McMahon. “Other times, the guilt is about [making] the choice to protect their family first and not go to the hospital to treat patients.” 

Among 300 Palestinian MSF staff in Gaza is Dr. Ruba Suliman, who works at Rafah Indonesian Field Hospital. She has been displaced from her home and is living in a shelter in Rafah, southern Gaza, with her husband and two children. 

“There is constant noise from the drones, which never leave us. Sometimes it’s really hard to sleep,” said Dr. Suliman. “I have this moral obligation to help people around me and I have this other obligation to save my kids.”

“We are alive, but we are not okay,” she said. “We are tired. Everybody here is devastated.”

Health care workers in Gaza face the same struggles as the other 2.2 million Palestinians living in the Strip. These doctors, nurses, and emergency responders have also lost their homes and loved ones, and many are living in tents and coping with grief. 

“It is not just about the house itself, it is about losing all the small things that made you who you are,” said another Palestinian MSF doctor. “My favorite coffee cup, my mother’s pictures, the shoes I liked so much.”

The psychological toll and human cost

The intensity and duration of exposure to these traumatic events are shattering the psychological state of many Palestinians in Gaza, including health care workers, some of whom say they come to work to not think about the war. But they nevertheless fear that what they see happening to their patients will happen to them or their loved ones. 

“Medical workers continue to work despite their emotional state, despite their constant worries about the safety and security of their families,” said Gisela Silva Gonzàlez, MSF mental health activity manager in Gaza. “This increases the level of stress at work, which is already very high in this context. The case of every patient can be an emotional trigger for health care workers.”

Looming offensive on Rafah adds to stress

An essential element required for psychological support and treatment is safety—and in an environment where not even the caregivers are safe, it is impossible to build resilience and coping mechanisms. No one and nowhere is safe in Gaza. According to local health authorities, since October 7, at least 34,000 people have been killed, including 499 health care workers, among them five of our MSF colleagues.

MSF’s mental health staff in Gaza say they are seeing symptoms linked to this level of continuous psychological stress and exhaustion. Staff experience anxiety, insomnia, depression, intrusive thoughts, emotional avoidance, and nightmares, all of which can heighten the risk of mental health issues. 

MSF is trying to provide urgent mental health care to medical staff, although a lot remains to be implemented to scale up this support. Davide Musardo, MSF mental health activity manager in Gaza, explained that the approach to mental health support for medical professionals is very different than for patients, because they possess more awareness of the impact of their work. 

“For our staff, we provide a different kind of activity, more based on their own experience,” said Musardo. “It is mainly a psychological intervention with the possibility to express to other professionals what they are going through. We try to give them a more specialized service through a lot of psychoeducation.” 

“When we say that there is no safe place in Gaza today, we are not just talking about the shelling,” said Amparo Villasmil, an MSF psychologist who worked in Gaza in February and March. “There isn’t even a safe place in people's minds. They live in a state of constant alert. They can't sleep, they think that at any moment they are going to die; that if they fall asleep, they won't be able to react quickly and run away, or protect their family.” 

Villasmil adds that health care workers and civilians alike are haunted and distressed by the prospect of an impending Israeli offensive in Rafah, where an estimated 1.5 million people are crammed and living in dire conditions. 

“Once, I found a colleague—a psychologist—on the stairs. He’s usually a very energetic and upbeat person but he was leaning his head on his knees. He was on the verge of tears and told me how exhausted he was,” said Villasmil about her colleague who had just heard about the confirmed offensive in Rafah. “He asked me what he was supposed to do, where he should go, and when this war would stop. I had no answers to give him.”